| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KYLE COOKE3 | 5304 MIDDLEBURY CT CLEVELAND, OH 44114 | PRIORITY HEALTH | $26K | — | $26K | 1.01% |
| CARMAN M. BAINES3 Filed as: CARMAN M BAINES | 85 CAMPAU AVE NW GRAND RAPIDS, MI 49503 | PRIORITY HEALTH | $13K | — | $13K | 0.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 330 W COLLEGE AVE APPLETON, WI 54911 | DELTA DENTAL OF MICHIGAN | — | $578 | $578 | 0.39% |
| HYLANT GROUP INC3 | 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 462900901 | METROPOLITAN LIFE INSURANCE COMPANY | — | $27 | $27 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC | JULIE LAVALLE 330 W COLLEGE AVE STE 201 APPLETON, WI 54911 | RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 5.94% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP INC-CARMAN BAINES | 811 MADISON AVE TOLEDO, OH 43604 | RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA | $995 | — | $995 | 4.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | 200 LIBERTY STREET NEW YORK, NY 10281 | FEDERAL INSURANCE COMPANY | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Contract Administrator; Claims processing Service code 12 | — | $12K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 227 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH | 359 | $2.6M |
| Dental | DELTA DENTAL OF MICHIGAN | 421 | $149K |
| Vision | RENAISSANCE LIFE AND HEALTH INSURANCE COMPANY OF AMERICA | 360 | $24K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 377 | $135K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 377 | $135K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 377 | $135K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 421 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.